Transition into PracticeHealthForceOntario Marketing and RecruitmentAgency

Laurie NashRegional Advisor

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Health System Transformation in Ontario

2012 Ontario’s Action Plan for Health Care

2015 Patients First Action Plan for Health Care

2015 Patients First: A Proposal to Strengthen Patient-Centred Health Care

2016 Bill 41 Patients First Act - Proposed

Primary Care Reform

Home & Community Care

Public Health

Expanded LHIN Role

OverviewØ There are 22 different remuneration models in Ontario for Family

Physicians

Ø Family Physicians can only belong to one type of model however they can practice fee-for-service outside of any agreement

Ø The fee schedule for each model is negotiated between the OMA and the Ministry of Health & Long-Term Care (MOHLTC)

Ø Once patients sign on with a particular physician they are considered “rostered” and the expectation is that the physician will provide all of the primary care for that patient

Ø Most clinical groups charge an overhead to the physicians. This is on average between 20% and 30% of the gross physician billings

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Evolution of Ontario’s Primary Health Care

Ontario’s primary health care models have been developed and modified in order to assist physicians in moving from solo practice to group based care.

Comprehensive Patient Care:

ØInterdisciplinary teamsØService integrationØImproved patient outcomes

• chronic disease Management• health promotion• disease preventionCOMPREHENSIVE CARE MODEL

FAMILY HEALTH GROUP

FAMILY HEALTH NETWORK

FAMILY HEALTH ORGANIZATION

RURAL & NORTHERN PHYSICIANGROUP

COMMUNITY HEALTH CENTRE

GROUP HEALTH CENTRE

FAMILY HEALTH TEAM

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Primary Care Models

FFS Fee For Service

CCMComprehensive Care Model

FHGFamily Health Group

Fee For Service FHN

Family Health Network

FHOFamily Health Organization

Capitation Based CHC

Community Health Centre

BSMBlended Salary Model

RNPGARural & Northern

Salary Based

Managed Entry Process

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Fee for Service (FFS)

Designed for solo physicians:

ü Bill OHIP for each service or procedure performedü Rewards high visit rateü No income if sick/offü No commitment to roster patients

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Comprehensive Care Model (CCM)

Designed for solo physicians:

ü Sign agreement to joinü No commitment to roster patientsü Regular hours and after-hours service ü FFS plus incentives

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Family Health Group (FHG)

Designed for groups of physicians:

üFee for service compensation (FFS)ügroup of 3 or more ü Incentives/bonusesü Patient enrolment strongly encouragedü After Hours Service – dependent on size of group.

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Community Health Centre (CHC)Inter-disciplinary Group of Providers:

üPhysicians are salaried, urban or rural ratesüPhysicians are employees of the CHCüWork as part of an inter-professional teamüCHCs often provide services to specific populations (low-income, high risk, complex, culturally-sensitive, LGBTQ+) ü Provide other programs and services to support patients (dental, nutrition, literacy)üCHC’s emphasize holistic approach

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Family Health Network (FHN)Physician paid blended capitation/blended alary/complement base remuneration

üPhysician group of 3 or moreü Incentives/bonuses/premiumsüMust roster patients

54 codes – lower base rateBase Rate based on sex and age of patient PLUS bill OHIP for each service or procedure performed but only paid “Shadow Billing” fee of 15%.

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Family Health Organization (FHO)Physician paid blended capitation/blended salary/complement based base remuneration

üPhysician group of 3 or moreüIncentives/bonuses/premiumsüMust roster patients

158 codes – higher base rateBase Rate based on sex and age of patient PLUS bill OHIP for each service or procedure performed but only paid “Shadow Billing” fee of 15%

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Capitation: Roster / Enrol – FHN & FHO

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Enrolled Patients Non-Enrolled Patients

üSign a Consent to Release Information form

ü Receive Base Rate per patient

+ shadow billing + access bonus+ other premiums + FFS billings from the Basket of Codes

üNo Base rate or access bonus

üReceive 100% FFS billing to a ceiling of $48,500 x number of MD’s

After hours / on call commitment for FHO/FHN groupsOne 3-hr session in evening/weekend per MD per week up to 5 sessions for groups with a maximum of 9 physicians

Exemption – northern and rural FHN and FHO’s who require active hospital privileges of 50% or more docs

Group can request a waiver from MOHLTC for after hours if >50% provides (exemptions are not automatic):üHospital /In patient, hospital on call, nursing home/LTC including on call, are coroners, palliative care (incl. call) coverage

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Family Health Team (FHT)

Family Health Teams are models of care delivery, NOT physician

funding models Patient

Nurse

Nurse Practitioner

Social Work

MD

Chiropody

Pharmacy

Care Navigator

Dietician

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Family Health Team (FHT)NOT A FUNDING MODEL FOR PHYSICIANS

• FHTs are a model of care delivery• Provide programs and services for patients at no additional cost• Governance• FHN/FHO Groups are associated with FHTs – provide the primary care for patients• 200 capitation models (FHN/FHO) applied and were accepted for FHT funding

• Funding:üInter-professional health providers (IHP) salariesüClerical Staff, Manager or EDüOperational expenses related to IHP (not MD)

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Discussion - Each model has PRO’s & CON’s

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Primary Care Models – A “quick” SummaryModel # of

PhysiciansRoster Providers Payment After Hours

FFS 1 n/a n/a Billing Not required.

CCM 1 ü Physician FFS + Incentives ü

FHG Min 3 ü Physicians(Nurses, NP)

FFS + Incentives ü

FHN Min 3 ü Physicians(Nurses, NP)

Capitation + FFS Billings, Bonus

ü

FHO Min 3 ü Physicians(Nurses, NP)

Capitation + FFS Billings, Bonus

ü

CHC Based on $ from LHIN

ü Interdisciplinary Team

Salary + Incentives

ü

BSM Community-SponsoredFHT $

ü Physicians

Interdisciplinary Team

Salary +incentives

ü

RNPGA üAll Community

PhysiciansNurses

Base + incentives

Reg. Office, On-Call, ED

Managed Entry into FHN/FHOsJune 1, 2015: New process for entry into Patient Enrollment Models (FHNs/FHOs) effective• 20 Physician spots available/month for new registrations in FHN/FHO groups

• Entry into FHNs/FHOs as an additional member of the group or the creation of new groups is only permitted in High Needs Community list (www.health.gov.on.ca/en/pro/programs/highneed/)

• Income Stabilization program only available to physicians joining groups on High Needs Community list

• High Needs Community list is updated periodically throughout the year and includes communities across the province. Not restricted to rural & remote

• List is developed and updated by the MOHLTC and includes local priority communities as identified by Local Health Integration Networks (LHINs) in consultation with stakeholders, including HealthForceOntario Marketing and Recruitment Agency (HFOMRA) Regional Advisors

Vacancy / Replacement Entry into FHN/FHOs

June 1, 2015: New process for entry into Patient Enrollment Models (FHNs/FHOs) effective

• Unlimited physician spots available per month for vacancy replacement

• Possible to join a FHO/FHN group in any area if you are replacing a physician who has left the group due to retirement or relocation

• FHN/FHO groups can fill any vacancies in their complement as determined by their March 31, 2012 level or the highest complement level after March 31, 2012

• In some circumstances the Ministry may consider a 2:1 replacement if the physician being replaced has a large practice. To be determined on a case-by-case basis

New Graduate Entry Program (NGEP)

October 2015: MOHLTC introduces New Graduate Entry Program (NGEP)

• Optional pathway to registrations in FHN/FHO groups in communities not on the High Needs list

• Minimum three years salary (FTE rate = Yr 1: $162,000, Yr 2: $178,000, Yr 3: $207,000)

• Meet or exceed performance targets in terms of Access, Preventative Care, Patient Experience and Patient Enrollment to enter FHN/FHO

• Patient enrollment targets (FTE = Yr 1: 825, Yr 2: 1000, Yr 3: 1200)

•In year one, no additional OHIP billing beyond NGEP pay is permitted

• Program includes mentor component to support new physicians in transition into practice

The Locum ExperienceBenefits of providing locum coverage:ü Diverse clinical experiences in different locations and an opportunity to pay off student debtü Opportunity to explore new ways of practicingü Could take a working vacation with the family or gain experience in various settings or build skillsü A way to transition into full-time practice

Opportunities:üMay be as short-term (day or # of hours) or long-term (6 months + for parental leave)üAvailable in all areas across the provinceüAvailable for any practice specialty 21

Locum PlacementsRequirements for physicians doing locums:

ü CPSO Independent Practice Licenseü OHIP Billing Numberü CMPA Insurance üHospital Privileges (depending on location)

Additional information that may be requested:ü CVü References (typically 3)ü CCFP or RCPSC certification

Ensure you sign a locum contract.

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Rural Family Medicine Locum Program (RFMLP)Opportunity to explore communities and practices in eligible communities across the province.

Vacant shifts posted online – HFOJobs.ca

Eligibility: Locum Physician RequirementsØValid independent CPSO license ØActive OHIP billing numberØMember of Canadian Medical Protective Association (CMPA)ØValid ACLS and ATLS certification

Eligibility: Rural PhysicianØPractice in a community with a RIO of 75 or over; or a RIO between 40 and 74 and with either 7 or fewer GP/FPs; orØSignatory to a Rural Northern Physician Group Agreement (RNPGA)ØMust practice general/family medicine full-time in eligible communityØMust confirm eligibility with HealthForceOntario Marketing and Recruitment Agency (HFO MRA)

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Be Positive, Professional & Prepared• Network: Talk to currently practicing physicians, senior residents, connections from med

school & residency, recent graduates .• Share your interests & ask for advice.• Approach each opportunity with the desire to learn and contribute in a positive way. • Make a good impression.• Attend conferences & job fairs.

• Get involved: Leadership, committees, research, events.

• Consider various settings and locations: Electives or Locums.

• Embrace the CanMEDS Framework : Be a team player.

• Create a job search plan: Work with the HFO MRA Regional Advisor and search for jobs using HFOJobs.ca

Preparing to Practice

• Comprehensive job search portal

• Free for all users• Search by specialty or

community• Create Job Alerts • Bookmark favourite communities• Apply for positions directly• Currently over 1,000 physician

postings

HFOJobs Website: www.HFOJobs.ca

Questions

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Laurie NashRegional Advisor

Erie St ClairHealthForceOntariol.nash@healthforceontario.ca

519-350-1809

practiceontario@healthforceontario.ca28

Key LinksHFOJobsTransition into Practice Service (TiPS) – ModulesRural Family Medicine Locum Program

College of Physicians and Surgeons of Ontario (CPSO)CPSO Practice Guide

The Canadian Medical Protective Association (CMPA)

CMA Practice Management ModulesNew in Practice GuideResident Timeline Tool

OMA Practice Management ResourcesOMA – Physician Health Program

MOHLTCOn-line Resource Manual for Physicians (OHIP Billing #, Claims Process)Schedule of Benefits – Physician Services Under the Health Insurance Act

Medical Liability Protection (MLP) Reimbursement ProgramNorthern Rural Recruitment & Retention Initiative

Professional Association of Residents of Ontario (PARO)Career Counseling Handbook

Resident Loan Interest Relieve ProgramApplication (Eng)Application (FR)Questions: rlirp@ontario.ca or 1-877-957-5747

Return of Service for IMG (Eligible Areas)www.healthforceontario.ca/rosmap-enwww.healthforceontario.ca/rosmap-frQuestions: teresa.cheung@ontario.ca or 416-327-8339

Institute for Clinical Evaluative Sciences (ICES)

Local Health Integration Networks (LHINs)

Ontario Physician Human Resource Data Centre

OntarioMD

Health Quality Ontario

Key Links (Cont.’d)